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Robyn Dayton is a technical officer at FHI where she works on the research utilization portfolio of youth reproductive and sexual health activities.
The findings of HPTN 052, that “men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by 96 percent through early initiation of oral antiretroviral therapy” (see full story here), give the HIV prevention community a new and potentially highly effective tool in its efforts to reduce the spread of HIV.
Simply put, starting antiretroviral therapy (ART) before it’s required for one’s own health can substantially decrease the risk that a person living with HIV will pass the virus on to his or her sexual partners—a discovery that could be an incredible boon for young people, the group that has the most new HIV infections per capita. (Every day, some 2,500 young people acquire HIV, and young people accounted for 41% of new infections in those over 15 in 2009.)
However, there are two clear prerequisites to realizing the promise of this approach for youth, and neither one of them is all that likely to be met. First and foremost, in order to start ART, a young person has to know his or her status—most young people infected with HIV don’t. (After all, if a young person can’t admit that she’s sexually active, she certainly doesn’t want to go seeking evidence, in the form of a positive HIV test, that this is the case.) Second, it’s often an older person who infects a younger one—especially older men having sex with young women—so young people knowing their status isn’t enough. Older people who have sex with young people need to not only know their status, but also care enough about their young partners to begin taking ARVs before it is necessary for the maintenance of their own health. But in societies where women have little value and young women need to seek out older partners in order to meet their financial needs, the power differential in this type of partnership doesn’t lend itself to both partners’ health having equal value.
So how likely are young people to benefit from this new finding?
If this sounds cynical, it isn’t meant to be. HPTN 052 offers hope for a number of people worldwide and is an incredible step forward in HIV prevention. However, it is important to think about whether those who most need a cutting edge HIV prevention strategy (youth) will have the opportunity to benefit from it. And if the answer is no, it’s up to the people who care about youth to work toward a world in which that opportunity is created.